ASSISTING AN AGING POPULATION: DESIGNING

MEDICAL DEVICES WITH FORCE SENSING

TECHNOLOGY
TABLE OF CONTENTS

Summary ............................................................................................................................................. 3
The Aging of a Nation .......................................................................................................................... 3
Key Features of Assistive Medical Devices .......................................................................................... 4
Force Sensing Technologies ............................................................................................................... 4
Assistive Living Devices with Force Feedback ..................................................................................... 5
Bed Monitoring System .................................................................................................................... 6
Smart Mobility Devices ..................................................................................................................... 6
Shoe Insole ...................................................................................................................................... 7
Occupational Therapy Devices ........................................................................................................ 7
Rehabilitation Device for Rheumatic Patients ................................................................................... 8
Conclusion........................................................................................................................................... 9
References ........................................................................................................................................ 10
Summary

With the geriatric population on the rise, design engineers are challenged with designing responsive,
noninvasive, user-friendly medical devices that cater to the needs of an older generation. Patients are
looking for cost-effective, easy to use assistive tools that help them regain independence and
confidence in their everyday life. Force feedback is a key feature for many of these devices that
provide the user and doctor with great insight that ultimately results in better quality of life for the
patient. Medical devices with force feedback allow design engineers to create innovative products that
differentiate them from the competition.

The Aging of a Nation

According to the United States Census Bureau, between now and 2050, the United States will
experience exponential growth amongst its older population. Reports conclude that by 2050, the
population, aged 65 and over, is projected to be 83.7 million, almost double the estimate from 2012
(see Figure 1). These population statistics create concern and challenges for the healthcare industry,
including policy makers and health care providers. Healthcare professionals around the world
recognize this challenge and how it will revolutionize the market for medicine and medical devices
specifically catered to the geriatric population.

Figure 1: Geriatric Population Chart

The global market for geriatric medical devices is expecting a compounded annual growth rate
(CAGR) of 6.9% during the forecast period of 2013 to 2019, according to a new market report
published by Transparency Market Research.1 This substantial growth provides opportunity for
medical device manufacturers to meet the demand for these assistive medical devices. Those 65 and
over are looking for easy-to-use, cost-effective devices that do not interfere with their everyday
lifestyle. These devices are also important to the elder patients family and physician because these
tools allow them to track their loved ones activity and progress. There are a variety of assistive
devices used amongst the geriatric population, including activity monitoring systems, smart mobility
devices, as well as occupational and physical therapy devices.

1
"Elderly and Disabled Assistive Devices Market- Global Industry Analysis, Size, Share, Growth, Trends and
Forecast, 2013 2019."
3

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Key Features of Assistive Medical Devices
The goal of assistive devices is for the patient to regain or maintain their independence and grow
confidence in their ability to function to their own expectations or those of a physician. These devices
must be affordable and user-friendly. If a patient uses an assistive medical device improperly, it can
do more damage than good. Today, most devices are technologically savvy, implementing some kind
of wireless, Bluetooth feedback system. Feedback is the key. The device needs to be responsive, and
provide the user or doctor with unique data. This data is used to eliminate guesswork and allows the
doctor to make diagnoses that are more justified.

Design engineers now have the ability to integrate force sensing technology into simple modern
medical tools, enhancing the devices features and capabilities. Intelligent devices with force feedback
increase the effectiveness of patient care and provide constant, consistent monitoring of a patients
health. When it comes to designing a new product or tool, the design engineers main focus is finding
the most efficient, cost effective components to integrate into their medical device design. The
engineer must consider a variety of factors when constructing a new device. These factors include
accuracy, size, cost, and more importantly to the medical world, safety and consistency. Patients and
doctors are looking for reliable tools with high accuracy; therefore, design engineers are challenged
with finding components that fit the needs of both the user and their project criteria.

Force Sensing Technologies

One of the most important elements of a medical device is the feedback it provides the person using
the tool, whether it is a primary care physician or patient. The device design must support a flow of
communication between the patients body, the tool used, and the doctor or user reading and
analyzing the output. There are a few ways that force can be measured, but depending on the context
of the application, some force sensing technologies prove to be a better fit than others.

Figure 2: Load Cell

Figure 3: Strain Gauge
Measurement

Load cells, strain gauges, and piezoresistive elements are devices used to measure force. The most
well known device used to measure force amongst researchers and engineers is the load cell. Load
cells can use a variety of technologies to sense loads, but are bulky in size; making them difficult to
design into an application where lightweight and small size are priorities.

To obtain force measurements, engineers commonly use strain gauges. Strain gauges are smaller
than load cells, but yield measurements that are a result of indirect force measurement drawn by
correlating the strain of an assembly with a load.

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Both technologies also require expensive electronics to obtain accurate force readings. In recent
years, a different approach to force sensing technology has become commercially available. The
generic term for this device is the tactile force sensor. Typically built on a flexible circuit material,
these sensors are sensitive to touch. Tactile sensors are thin, lightweight, and flexible; making them
ideal for integrating into a variety of products, including medical devices.

One example of a thin, tactile force sensor is the FlexiForce sensor manufactured by Tekscan, Inc.
FlexiForce sensors consist of special, proprietary, piezoresistive material sandwiched between two
pieces of flexible polyester. The polyester has printed silver conductors on each inner half. These
conductive traces form electrical connections to external circuits. These force sensors are resistors
that vary linearly in terms of conductance vs. force under an applied load. FlexiForce sensors come in
off-the-shelf standard shapes for test and measurement, as well as proof of concept, but are also
customizable for specific Original Equipment Manufacturer (OEM) applications. Tactile force sensors
are easier to integrate into products and systems as compared to the other force sensing options due
to their thin, flexible nature.

Figure 4: Thin, Flexible FlexiForce Sensor with Multimeter

Assistive Living Devices with Force Feedback

Force sensing technology is also an important feature in medical devices used outside a hospital
setting. After a diagnosis, a patient will most likely return to his or her everyday life with the assistance
of medication or some form of medical device. An assistive living device helps monitor the patients
health or activity and status of progression. Because the patient usually carries around these types of
medical devices, it is important for the device to be lightweight, and noninvasive. Small, thin, tactile
force sensors provide a simple solution designed to receive accessible data with ease in devices such
as these. Below are a few medical devices designed with force sensors that ensure proper feedback
and enhance the user experience:

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Bed Monitoring System
Monitoring systems are a way for doctors, patients, and their loved ones to keep constant track of a
patients day-to-day activities in the comfort of their own natural environment. New medical devices
are allowing doctors twenty-four hour access to this insightful information regarding a patients
progression and everyday routine. Real-time monitoring systems are becoming increasingly popular in
geriatrics, specifically keeping a close eye on elderly patients. Force sensors are integrated into
wearable medical devices as well as stationary furniture.

Figure 5: Bed Monitoring System with FlexiForce Sensor

For example, FlexiForce sensors are designed into a bed monitoring system (Figure 5) where the
sensors are strategically placed underneath the legs of a bed to determine if force is being exerted or
not. This data confirms whether or not someone is lying on the bed. The sensors are also calibrated
so that the system can confirm if pressure is being exerted by a human subject rather than a pet or
inanimate object. The force sensors provide continuous data for relay to the doctor or the patients
family members via a wireless hub. This data provides insight into the patients daily activity or lack
thereof, which in turn would alert doctors, caregivers, or family members to check in on that patient.
Medical devices such as these allow doctors to stay informed and connected to their patients,
resulting in better insight to their overall well being and activity level.

Smart Mobility Devices

According to the Centers for Disease Control and Prevention (CDC), one out of three older adults
(those aged 65 and older) falls each year. Among older adults, falls are the leading cause of both fatal
and nonfatal injuries. Most of these falls result in mobility problems. Assistive mobility devices, such
as walkers and rollators (Figure 6), are in high demand. Walkers and rollators are everyday tools that
allow patients to regain their natural gait and independent mobility.

Researchers at the Centro De Investigacin y De Estudios Avanzados Del Instiuto Politcnico

Nacional created a smart walker prototype using FlexiForce sensors to help patients achieve a more
natural gait. The device was designed by adding two FlexiForce sensors to the hand supports of a
walker and two small motors of DC voltage to the front wheels.

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A microcontroller that uses a pulse width algorithm controls
the walkers speed. The microcontroller communicates via
Bluetooth, translates the force applied and sends it to the
laptop for processing. The changes in the force may be
indicative of a neuromuscular disorder or injury. The
quantitative data resulting from the load forces allows the
user or a doctor to examine and identify irregular load
ranges and rhythms, which can be attributed to certain
diseases. This smart device allows physicians to make
better diagnoses and treatment plans.

Figure 6: Rollator
Shoe Insole
Due to the frequency of falls among the elderly, preventative mobility devices are becoming
increasingly popular in the medical device market. These devices help patients with their balance and
aim to prevent falls from occurring. Shoe insoles (Figure 7) designed with force feedback provides
quantitative data that allows doctors to track and analyze their patients gait and rehabilitation
progress. In-shoe devices also act as a monitoring system that has the ability to alert family members
if their loved one has fallen or deviated from their everyday routine. Recently, a 15-year-old student,
Kenneth Shinozuka, invented a sock with a force sensor to help track patients diagnosed with
Alzheimers. Patients diagnosed with Alzheimers tend to wander, which is a great concern to family
members and caregivers. This sensor is worn at the bottom of the foot, detecting pressure
measurements. The sensor sends signals alerting the caregiver if movement is made. The
piezoresistive sensor is the perfect fit for this medical device because it is thin, flexible, and accurate.

Figure 7: FlexiForce sensor designed into shoe insole

Occupational Therapy Devices

Activity monitoring and preventative care are just a few of the markets for geriatric medical devices.
Occupational therapy devices are also in demand to help patients with rehabilitation. These devices
aim to help the patient regain strength, endurance, and normality. Force sensors are an ideal
component of these tools because they produce feedback. This allows therapists to track the patients
progression and set up an effective recovery plan. Those aged 65 and older are at greater risk for
falls, strokes, Alzheimers, and muscular disorders.

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Rehabilitation Device for Rheumatic Patients
In 2013, a group of bioengineers and rheumatoid specialists in Cagliari, Italy designed a low-cost
medical device that monitors the hand rehabilitation of patients diagnosed with Rheumatoid Arthritis
(RA) and Systemic Sclerosis (SS). The device consists of sensorized tools, using FlexiForce sensors
and can be used either in an outpatient clinic or in a patients home. Clinicians strongly advise
pharmacological treatment partnered with kinesiotherapy, to help improve rheumatic patients quality
of life. According to the American Kinesiotherapy Association, kinesiotherapy is the application of
scientifically based principles to design specific exercises aimed to enhance the strength, endurance,
and mobility of individuals with functional limitations, which require extended physical conditioning.

Figure 8: Rehabilitation Device & Hand Exercises Utilizing FlexiForce Sensors

Force sensors are designed into this medical device to provide force feedback data to the clinician
and patient. This tool provides a simple and objective monitoring of a patients rehabilitation sessions
and progress. The design of the device centers around seven hand exercises tailored for RA and SS
patients rehabilitation. These seven exercises include: hand pinch, hand grip, finger pinch (opposition
to the thumb), isometric rotation, hand extension, rotation (fast manipulation), and finger tapping.
FlexiForce A201 sensors were used specifically in the hand pinch, isometric rotation, hand grip, and
finger pinch applications (Figure 7). The sensor measures the force applied by the patient. This
information is then relayed through custom software and evaluated by the clinician.

Haptic feedback provides insight to the doctor and the user unobtainable by other medical devices
without force feedback. This real-time data is valuable in measuring rehabilitation in a quantitative
way. Force sensors can be used in any physical or occupational therapy device to measure how
much force or pressure is being applied to either a certain body part or how much force that part of
the body is able to exert. Medical devices with these capabilities help increase patient care and the
overall rehabilitation process.

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Conclusion
Force-sensing technologies are now an integral component in a variety of geriatric medical devices.
The capability of the device to maintain proper communication with its user is a desired function that
has become a standard medical device feature. FlexiForce sensors are a thin, easy to integrate and
customizable design option. If designed into a device, these tactile sensors help eliminate guesswork
for the user by producing tangible and quantifiable data. The data produced by sensors and
electronics allows doctors better insight into their patients health and recovery process. These smart
force-sensing devices result in better treatment and understanding of an aging population. FlexiForce
sensors enhance medical devices by adding intelligence and broadening the scope of the tools
capabilities.

To learn more about force sensors and custom capabilities, please visit
https://www.tekscan.com/product-group/embedded-sensing/force-sensors

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References
Danilo Pani et al. A Device for Local or Remote Monitoring of Hand Rehabilitation Sessions for
Rheumatic Patients,IEEE Journal of Translational Engineering in Health and Medicine, vol.2,
pp.1,11, 2014

Falls Among Older Adults: An Overview. (n.d.). Retrieved May 1, 2015, from Centers for Disease
Control and Prevention website: http://www.cdc.gov/HomeandRecreationalSafety/Falls/
adultfalls.html

Ortman, Jennifer M., Victoria A. Velkoff, and Howard Hogan. An Aging Nation: The Older Population
in the United States, Current Population Reports, P25-1140. U.S. Census Bureau, Washington,
DC. 2014.

Sottile, C. S. (2014, September 14). Teen Invents Sensor to Help Alzheimer's Patients. Retrieved
from NBC News website: http://www.nbcnews.com/feature/making-a-difference/
teen-invents-sensor-help-alzheimers-patients-n203231

Source: (2008) IEEE Sensors Conference, Gaddam, A., Gupta, G., Mukhopadhyay, S., Necessity of a
Bed Sensor in a Smart Digital Home to Care for Elder People, 1340-1343.

Springer International Publishing Switerzland 2015. A. Braidot and A. Hadad (eds.), VI Latin American
Congress on Biomedical Engineering CLAIB 2014, Paran, Argentina 29, 30, & 31 October 2014,
IFMBE Proceedings 48, DOI: 10.1007/978-3-319-13117-7_182

Transparency Market Research. Elderly and Disabled Assistive Devices Market (Medical Mobility Aids
and Ambulatory Devices, Medical Furniture and Bathroom Safety Products, Hearing Aids and
Vision & Reading Aids) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013
2019.

United Nations, Department of Economic and Social Affairs, Population Division (2013). World
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